Fungal infections in cancer patients are difficult to diagnose and such diagnoses are frequently only made at necropsy. Aspergillus infections were common at the BCRC (see #6264 regarding prevention) and were usually fatal, but as diagnostic procedures improved, earlier therapy became possible. Therefore, 17 consecutive patients with documented aspergillosis were reviewed to determine the impact of earlier diagnosis and prompt treatment with amphotericin B. Sixteen of the 17 had hematologic malignancies, and all had marked granulocytopenia. Six patients were diagnosed and treated within 96 hours of the appearance of infiltrates; three had complete resolution and three had a partial response to therapy despite continued granulocytopenia. Thus, aggressive diagnostic techniques are warranted. We are now evaluating the addition of rifampin to amphotericin B, known to be synergistic against some fungi in animal models, for early therapy. Thirty-five patients have been randomly allocated to date to amphotericin B rifampin, but after stratification for the various fungal infections, there are too few patients from which to draw meaningful conclusions other than that early application of therapy continues to be the best approach to infection resolution.